Abnormal performance of peroral endoscopic myotomy (POEM): a case misdiagnosed as achalasia of cardia

• Published in: Journal of cardiothoracic surgery Vol. 19; no. 1; p. 214
• Main Authors: Yu, Wen-Quan, Gao, Hui-Jiang, Zhai, Li-Xue, Wei, Yu-Cheng
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15-04-2024; BioMed Central; BMC
• Subjects: Abnormalities; Achalasia; Adenocarcinoma; Cancer; Cardia - surgery; Case Report; Case reports; Computed tomography; CT imaging; Diagnosis; Diagnostic Errors; Dyskinesia; Dysphagia; Endoscopy; Esophageal Achalasia - diagnosis; Esophageal Achalasia - surgery; Esophagogastric Junction - surgery; Esophagus; Fibroids; Gastroenterology; Humans; Lesions; Literature reviews; Male; Medical imaging; Medical prognosis; Methylene blue; Middle Aged; Motility; Mucosa; Myotomy; Oncology; Patients; Peroral endoscopic myotomy; Prognosis; Pseudoachalasia; Systematic review; Tumors; Ultrasonic imaging; Peroral endoscopic myotomy; Achalasia; Pseudoachalasia
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-024-02688-w

Pseudoachalasia is a rare disease that behaves similarly to achalasia (AC), making it sometimes difficult to differentiate.
We report a case of 49-year-old male with adenocarcinoma of the gastroesophageal junction misdiagnosed as achalasia. No obvious abnormalities were found in his initial examinations including upper digestive endoscopy, upper gastrointestinal imaging and chest computed tomography (CT). During the subsequent introduced-peroral endoscopic myotomy (POEM), it was found that the mucosal layer and the muscular layer had severe adhesion, which did not receive much attention, delayed the clear diagnosis and effect treatment, and ultimately led to a poor prognosis for the patient.
This case suggests that when patients with AC found mucosal and muscular adhesions during POEM surgery, the possibility should be considered that the lesion may be caused by a malignant lesion.